Transgender lives from an African perspective

Top Surgery

As trans people embark on the journey towards themselves, transitioning, many of them choose to undergo top surgery. Top surgery is a general term the surgical procedures performed on the breasts of transgender patients. For transwomen they undergo breast augmentation surgery and transmen undergo mastectomy together with chest reconstruction surgery.

Breast augmentation mostly known as “boob job” refers to artificial enlargement of breasts. This article will mainly focus on transmen top surgery.

Mastectomy refers to the removal of the breast tissues. Chest reconstruction involves creating a “male” looking chest. • removing most of the breast tissue • removing excess skin • removal of the crease where the breast meets the chest wall (inframammary fold) • resizing and repositioning the nipple and the dark area around it (areola) It also includes preserving as much sensation as possible and trying to minimize scarring.

There are three possible techniques that can be used, depending on the size of your chest, the elasticity of your skin, and your preferences:

Keyhole: This is used for small breast(A cup or small B cup) with good skin elasticity. Incision is made along bottom border of areola. Breast tissue is removed via a small incision under or across the areola. Nipples are not resized or repositioned.

Drawstring/Pursestring Used for Moderate size breasts (B or C cup), with good skin elasticity. Incision/scar circle around the edge of areola. Breast tissue is removed via an incision around the edge of the areola. A ring of skin is then removed in a wider circle around the areola incision, and the skin is pulled toward the center of the opening and stitched to the edge of the areola. This creates an effect similar to pulling a drawstring bag closed. Areola may be trimmed to reduce its size. It may be possible to slightly reposition the nipple Some surgeons leave the nipples partially attached via a stalk (pedicle) of tissue and move the entire stalk to try to preserve sensation.

Mastectomy with free nipple grafts (double incision) Used for large or saggy breasts, or inelastic skin. Incision/scar horizontal or U-shaped cuts across each breast, usually just below the nipple. The aim is to place the incisions just under the line of the pectoral muscles so it is not highly visible. The skin is peeled back and the breast tissue and excess fatty tissue are removed. The excess chest skin is then trimmed and the incisions closed. Nipples are removed, trimmed to smaller size, and grafted onto the chest to approximate positioning of “male” nipple.

As part of considering which technique to have, it’s important to consider your goals in terms of the balance between nipple appearance and sensation. The more the size and position of the nipple is changed, the less sensation you’ll have. If nipple sensation is not important to you but nipple appearance is, a nipple graft may be your best bet. If nipple sensation is very important to you, talk with the surgeon about techniques to reposition the nipple without removing it.

DISCLAIMER: The information contained herein is to be used for educational purposes only. The author is not a medical professional, and this information should not be considered medical advice. This information should NOT be used to replace consultation with or treatment by a trained medical professional.